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the three major sx of menieres
vertigo
deafness
tinnitus
what are other sx of menieres other than the 3 major sx
aural fulness
causes of menieres disease
multifactorial
problems with endolymph (concen/amt)
improper fluid drainage
abnormal immune response
allergies
viral infection
genetic disposition
head trauma
what does a dx of menieres disease require
two spontaneous episodes of vertigo each lasting 20 min
hearing loss verified by hearing test at least one occasion
tinnitus or aural fullness
R/O
what is the AAO-HNS objective outcome of menieres therapy
control of vertigo
what is a Class A complete control of vertigo
CoV=0
what is Class B substanial control of vertigo
CoV 1 - 40
what are the two types of treatment for menieres disease
modulate/reduce severity and frequency of attacks
target single symptom (usually vertigo) by ablating vestibular end organ
what is the purpose of modifying your diet in menieres disease
to reduce fluid retension and help decrease fluid in the ear
what are some of the dietary changes that can take place
eat regularly
limit salt (aim for 1500mg or less/day)
avoid MSG
what are some medications used during an episode of vertigo
meclizine (antivert) or diazepam (valium) may reduce spinning sensation of vertigo and help control n/v
promethazine for N/V
what are some of the long term medications used for menieres
diuretic (reduce fluid retension)
what are the noninvasive therapies and procedures used to treat menieres
vestibular rehab (exercise and activites)
hearing aid
meniett device (positive pressure to inner ear to improve fluid exchange)
middle ear injections for menieres disease
gentamicin
steroids
what is the risk of gentamicin inner ear injections
further hearing loss
which inner ear injection is less likely to cause hearing loss
steroid injection
surgical procedures used to treat menieres
endoplymphatic sac procedures
vestibular nerve section
labrinthectomy
what role does the endolymphatic sac play in the ear
regulates inner ear fluid levels by inc/dec fluid production and absorption
what is endolymphatic sac decompression
a small portion of bone is remove from over the endolymphatic sac and sometimes this procedure is coupled with the placement of a shunt to drain excess fluid from your inner ear.
what is a vestibular nerve section
cutting the nerve that connects balance and movement sensors in your inner ear to the brain (corrects vertigo)
what is a labrinthectomy
removal of a portion or all of the inner ear, thereby removing both balance and hearing function from the affected ear
what is labrinthectomy performed
when the pt has near total or total hearing loss
other lifestyle changes for menieres diesease
avoid caffeine
stop smoking
manage stress and anxiety
avoid allergens
what percent does bilateral vestibulopathy account for all dizziness
1%
what is bilateral vestibulopathy often due to
exposure to an ototoxic medication (50%)
what is the single most known cause of bilateral vestibulopathy